Prehospital/EMS and Hospital Reperfusion Time Goals for STEMI in 2025 ACS AHA/ACC guidelines:
Prehospital/EMS and Hospital Reperfusion Time Goals for STEMI in 2025 ACS AHA/ACC guidelines:
A second and/or third ECG during EMS transport may identify up to 15% of additional STEMI cases not present on the first ECG.
The 2025 American guidelines for STEMI (ST-Elevation Myocardial Infarction) emphasize specific time goals for reperfusion therapy to optimize patient outcomes. The numbers 90 minutes and 120 minutes in the attached flowchart represent key benchmarks in the treatment timeline:
1. 90 minutes (FMC-to-device time for PCI centers)
• If a patient presents directly to a PCI-capable center, the goal is to achieve primary PCI within 90 minutes from first medical contact (FMC).
• This applies to both EMS-transported and self-presenting patients.
• If possible, the emergency department (ED) should be bypassed, and the patient should be sent directly to the cath lab for immediate intervention.
2. 120 minutes (Transfer from a non-PCI center)
• If a patient arrives at a non-PCI hospital, the goal is to determine if PCI is feasible within 120 minutes from FMC.
• If PCI cannot be performed within this window, fibrinolysis should be administered within 30 minutes (door-to-lysis time).
• If fibrinolysis is given, the patient should be reassessed for reperfusion success and transferred for rescue or early angiography.
• If PCI is feasible within 120 minutes, the patient should be transferred urgently to a PCI-capable center, ideally bypassing the ED and going directly to the cath lab.
Summary
• 90 minutes is the gold standard for primary PCI if the patient is at a PCI center.
• 120 minutes is the maximum acceptable time for PCI if a transfer is required. If PCI within this time frame isn’t possible, fibrinolysis should be administered.
These benchmarks are Class 1 recommendations, meaning they are strongly supported by clinical evidence and should be followed to improve survival rates in STEMI patients.
The many stakeholders of regional systems of STEMI care (including hospitals, EMS companies, regional public health departments, and local governments) must ensure that all components of a STEMI system of care function in a coordinated way with no gaps in care processes to help optimize STEMI outcomes in the community.
Best clinical practice consists of patients calling 9-1-1 (or other emergency services) to activate EMS; EMS obtaining a prehospital ECG, activating the cardiac catheterization laboratory from the field for suspected STEMIs, and transporting the patient to the nearest PCI center when possible; and achieving a system goal of FMC-to-device time within 90 minutes. Successful STEMI systems have robust mechanisms for educating the public of the need to immediately call 9-1-1 (or other appropriate local emergency services) for ischemic symptoms and not driving themselves to the nearest hospital.
